Day 14
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
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| What enzyme catalyzes the RLS in carbohydrate digestion? | Oligosaccharide hydrolase (at the intestinal brush border)
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| What enzyme is responsible for the conjugation of bilirubin? | UDP glucoronyl transferase
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| What important secretory products are secreted from G cells in the GI tract? | Gastrin
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| What important secretory products are secreted from I cells in the GI tract? | CCK
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| What important secretory products are secreted from S cells in the GI tract? | secretin
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| What important secretory products are secreted from D cells in the GI tract? | somatostatin (SST)
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| What important secretory products are secreted from parietal cells in the GI tract? | intrinsic factor (IF)
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| What important secretory products are secreted from chief cells in the GI tract? | pepsinogen
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| What GI ligament matches the following description?: contains the portal triad and may be compressed to control bleeding | hepatoduodenal ligament
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| What GI ligament matches the following description?: attaches the spleen to the posterior abdominal wall | splenorenal ligament
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| What GI ligament matches the following description?: attaches the spleen to the stomach | gastrosplenic ligament
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| What drugs and endogenous H stimulate the secretion of gastric acid? | Histamine, ACh, and gastrin
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| What drugs and endogenous H inhibit the secretion of gastric acid? | prostaglandins, SST, secretin, GIP (gastric inhibitory polypeptide), PPIs, H2 blockers, and antimuscarinics (atropine)
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| Which H stimulate pancreatic secretion? | CCK (main one), secretin, and ACh (via vagus n)
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| What structures form Hesselbach's triangle? | Inferior epigastrics, inguinal ligament, rectus abdominus (lateral border). Somewhere, Mo is smiling right now...
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| Which hereditary hyperbilirubinemia matches the following statment?: mildly decreased UDPGT | Gilbert's and Crigler Najar Type II
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| Which hereditary hyperbilirubinemia matches the following statment?: completely absent UDPGT | Crigler Najar Type I (type I/one is not the I/one I would want!)
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| Which hereditary hyperbilirubinemia matches the following statment?: grossly black liver | Dubin Johnson syndrome
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| Which hereditary hyperbilirubinemia matches the following statment?: responds to phenobarbital | Crigler Najar Type II (also Gilbert's)
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| Which hereditary hyperbilirubinemia matches the following statment?: treatment includes plasmapheresis and phototherapy | Crigler Najar Type I
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| Which hereditary hyperbilirubinemia matches the following statment?: asymptomatic unless under physical stress (alcohol, infection) | Gilbert's
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| Which antacid matches the following statement: may cause diarrhea | Mg hydroxide (Must Go to the bathroom right now! uh-oh! too late!)
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| Which antacid matches the following statement: may cause constipation | Al hydroxide (aluMINIMUM amt of feces)
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| Which antacid matches the following statement: may cause rebound hypercalcemia | Ca carbonate
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| Which antacid matches the following statement: may cause hypokalemia | Mg hydroxide, Al hydroxide, and Ca carbonate
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| What enzyme is inhibited by PPIs (-prazoles)? | H+/K ATPase
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| What is the artery of the foregut? of the midgut? of the rectum and distal 1/3 of the colon? | Celiac a=foregut, SMA=midgut, IMA=hindgut
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| What is the MC location of salivary gland tumors? | Parotid gland
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| What is the MC salivary gland tumor? What is its histologic appearance? | Pleomorphic adenoma. Both epithelial and mesenchymal differentiation.
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| What is the 2nd MC benign salivary gland tumor? | Warthin's tumor
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| What is the MC malignant salivary gland tumor (the second MC tumor ovarll of the salivary gland)? | Mucoepidermoid CA
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| What is the likelihood that a parotid gland tumor will be malignant? | <30%
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| What is the likelihood that a sublingual salivary gland tumor will be malignant? | 70%
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| What is the biggest risk factor for a salivary gland malignancy? | Smoking (of course!)
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| A pt taking NSAIDs for the management of her gout develops anemia, has pain with eating, and is positive on occult blood test. What drug would most directly address the mechanism behind this pt's current problem? | Misoprostol
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| A newborn is having trouble feeding. He vomits milk when fed and has a gastric air bubble on x-ray. What kind of fistula is present? | Tracheoesophageal fistula
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| A 60yo man with chronic reflux presents with esophageal cancer. What is the most likely histologic subtype? | Adenocarcinoma
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| Specialized columnar epithelium seen in a biopsy from distal esophagus | Barret esophagus
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| Biopsy of a pt with esophagitis reveals large pink intranuclear inclusions and host cell chromatin that is pushed to the edge of the nucleus | HSV
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| Stomach biopsy reveals neutrophils above the basement membrane, loss of surface epithelium, and fibrin-containing purulent exudate | Acute gastritis
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| An esophageal bipsy reveals a lack of ganglion cells btwn the inner and outer muscular layers | Achalasia
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| Biopsy of mass in parotid gland reveals a double layer of columnar epithelial cells resting ona dense lymphoid stroma | Warthin tumor
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| Small intestine biopsy reveals small lymphocytes with irregular nuclear contours and proliferation of these lymphocytes into the mucosa and epithelial glands | MALT lymphoma (maltoma)
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| Outpouching of all layers of the esophagus found just aboe the LES | Epiphrenic diverticulum
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| Basal cell hyperplasia, eosinophilia, and elongation of lamina propria papilla seen in biopsy of esophagus | Chronic reflux esophagitis
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| Goblet cells seen in the distal esophagus | Barret esophagitis
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| Stomach biopsy reveals lymphoid aggregates in the lamina propria, columnar absorptive cells, and atrophy of glandular structures | Chronic gastritis
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| Protrusion of the mucosa in the upper esophagus | Esophageal web
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| Biopsy of a pt with esophagitis reveals enlarged cells, intranuclear, and cytoplasmic inclusions, and a clear perinuclear halo | CMV (whenever you see enlarged cells, always think of CMV first)
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| DIffuse thickening of gastric folds, elevated serum gastrin levels, biopsy reveals glandular hyperplasia without foveolar hyperplasia | Zollinger Ellison syndrome
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| Biopsy of mass in parotid gland shows both epithelial and mesenchymal differentiation | Pleomorphic adenoma
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| Biopsy of mass from parotid gland reveals a carcinoma composed of mostly mucus-secreting cells but also some squamous cells, and intermediate hybrids of both | Mucoepidermoid tumor
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| A PAS stain on a biopsy obtained from a pt with esophagitis reveals hyphenated organisms | Candida esophagitis
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| MCC of duodenal ulcers | H pylori
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| Esophageal pouch found in the upper esophagus | Zenker's diverticulum
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| What are the common causes of small bowel obstruction? | ABCs: Adhesions from previous surgeries, bulge/hernia, cancer/tumors (mostly metastatic colorectal cancer)
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| After the loss of his job, a 35 yo man has diarrhea and hematochezia (passage of fresh blood thru the anus). Intestinal biopsy shows transmural inflammation. What is the dx? | Crohn's disease
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| A weight lifter undergoes emergency surgery for a life threatening condition. Examination of a section of his small bowel reveals focal hemorrhages. What is the process respnsible for this? | Incarcerated inguinal hernia--> focal hemorrhages
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| A 40yo woman presents with having to defecate 4 times/day for several months along with a constant low-grade abdominal pain that is somewhat relieved by defecation. Colonoscopy is normal. What is the most likely diagnosis? | Irritable Bowel Syndrome (one of those pretend diseases where you feel better after you poo b/c you are full of it!)
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| 50yo man complains of diarrhea. On exam, his face is plethoric and a heart murmur is detected. What is the diagnosis? | Carcinoid syndrome (Be FDR: Brochoconstriction, Flushing, Diarrhea, R sided heart problems)
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| A SAAG > 1.1 is seen in what disease(s)? | Portal hypertension. Assoc'd with transudate.
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| A SAAG < 1.1 is seen with what disease(s)? | Cancer, nephrotic syndrome, TB, pancreatitis, biliary disease, connective tissue disease. Assoc'd with exudate.
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| A young man presents with ataxia and tremors. He has brown pigmentation in a ring around the periphery of his cornea. What treatment should he receive? | Penicillamine (copper penni-es)
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| An 80yo woman comes to your clinic because her family is concerned about her yellowing skin. Exam reveals yellowing of the skin including the palms and soles but no scleral icterus. What question could you ask the pt to ID the cause? | Do you eat a lot of carrots? Excess beta carotene in body can cause yellowing of the palms and soles. With jaundice, you should always see scleral icterus.
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| A 20yo man contracts influenze then presents with an idiopathic hyperbilirubinemia. What is the most likely cause? | Gilbert's syndrome
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| What is the fate of bilirubin after it is conjugated and secreted into the GI tract? | First it is acted upon by gut bacteria to form urobilinogen. Then some of the urobilinogen is excreted and some is reabsorbed.
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| A pt presents complaining of pain in the RUQ that he can point to with one finger. The area is tender to light touch, and pain is worsened when the pt is asked to raise his arms above his head. What is most likely this pt's problem? | Probably a musculoskeletal thing anytime they can point to the pain with one finger. In this case, he probably has a rectus abdominus tear. Could also be malingering.
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| MCC of acute RLQ pain | appendicitis
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| 50yo female presents with pruritis without jaundice. Lab reveals + AMA | Primary biliary cirrhosis
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| MCC of acute LLQ pain | Diverticulitis
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| Gluten sensitivity | Celiac sprue
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| A pt with GI bleeding has buccal pigmentation | Peutz-Jegher syndrome
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| 60yo female with rehumatoid arthritis and no alcohol history presents with fatigue and R abdominal pain, lab studies reveal high levels of ANA and ASMA, elevated serum IgG levels, and no viral serolgic markers | Autoimmune hepatitis
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| Colonoscopy reveals very friable mucosa extending from the rectum to the distal transverse colon | Ulcerative colitis
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| A small intestinal mucosa laden with distended macrophages in the lamina propria (that are filled with PAS + granules and rod-shaped bacilli seen by electron microscopy) | Whipple disease
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| MCC of RUQ pain | Cholecystits
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| Liver biopsy on a 23yo female with elevated levels of LKM-1 antibodies, no alcohol history, and no viral serologic markers reveals infiltration of the portal and periportal area with lymphocytes | Autimmune hepatitis
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| Diarrhea, fever, and abdominal cramps following a course of antibiotics | Pseudomembranous colitis
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| Fatal disease of unconjugated bilirubin resulting from a complete lack of UDPGT activity | Crigler Najar Type I
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| Radiography reveals a string sign in the terminal ileum | Crohn's disease
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| Total or subtotal atrophy of the small bowel villi, plasma cells, and lymphocyte infiltration into the lamina propria and epithelium, and hyperplasia/elongation of crypts | Celiac sprue
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| Nonfatal disease of unconjugated bilirubin resulting from low levels of UDPGT activity | Crigler Najar Type II or Gilbert's
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| Elevated levels of serum ferritin and increased transferrin saturation | Hemochromatosis
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| AFP >1000pg/mL | HCC
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| Elevated serum copper, decreased serum ceruloplasmin, and elevated 24 hour urinary copper | Wilson's disease
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| Liver disease + lung emphysema | alpha-1-antitrypsin deficiency
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| ERCP reveals alternating strictures and dilation | Primary sclerosing cholangitis
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| What is seen in Budd-Chiari syndrome? | Compression of IVC or hepatic v. See many of signs of portal HTN, but no JVD.
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| What conditions is Budd-Chiari syndrome associated with? | Pregnancy, polycythemia vera, and HCC.
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| What is the underlying problem in Wilson's disease? | Can't excrete Cu thru bile.
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| What are the characteristics of Wilson's disease? | See Kayser Fleischer ring in eye, asterixis, Parkinsonian symptoms, decreased ceruloplasmin, cirrhosis, Cu accumulation, HCC, dementia, dyskinesia, and dysarthria.
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| What is the treatment of Wilson's disease? | Penicillamine
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| What is the classic triad of symptoms in hemochromatosis? | Bronze diabetes (skin pigmentation), diabetes, and cirrhosis
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| What will the labs show with hemochromatosis? | Increased ferritin, increased transferrin saturation, increased serum iron, and decreased total iron binding capacity (TIBC)
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| What is the treatment for hemochromatosis? | Desferoxamine and phlebotomy
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| What are the possible etiologies of acute pancreatitis? | GET SMASHED: Gallstones, Ethanol, Trauma, Steroids, Mumps, Autoimmune disease, Scorpion sting, Hypercalcemia/hyperlipidemia, ERCP, Drugs (sulfa drugs)
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| What is the typical presentation of a pt with pancreatic insufficiency? | Steatorrhea, weight loss, ADEK deficiency, diarrhea, weakness
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| What is the treatment for pancreatic insufficiency? | Pancreatic enzyme replacement, ADEK supplementation, limit fat intake.
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| What are the risk factors for dveloping HCC? | Hep B and C, Wilson's disease, hemochromatosis, alpha-1-antitrypsin deficiency, hepatic adenoma, and alcoholic cirrhosis
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| What is the difference between primary biliary cirrhosis and primary sclerosing cholangitis? | PBC: young woman, autoimmune disease, + AMA, assoc'd with other autoimmune diseases.
PSC: men >40yo, unknown cause, + p-ANCA (60% of cases), a/w UC and cholangiocarcinoma, ERCP shows alternating beading and stricturing
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| What are the five 2's of Meckel's diverticulum? | 2" long, 2' from the ileocecal valve, 2% of the population, commonly presents in the first 2 years of life, 2 types of epithelium (gastric and pancreatic)
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| What are the tumor markers for pancreatic cancer? Which one is more specific? | CEA and CA 19-9 (more specific)
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| What is the typical histological neoplastic progression of colon cancer? | Tubular adenoma-> tubulovillous adenoma--> villous adenoma--> carcinoma
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| True or false: hyperplastic polyps are malignant. | False!
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